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Clinical Effects of Synthetic Cannabinoid Receptor Agonists Compared with Marijuana in Emergency Department Patients with Acute Drug Overdose

Journal of Medical Toxicology volume 12, pages 335–340 (2016)Cite this article

Abstract

Introduction

Synthetic cannabinoid receptor agonists (SCRAs) are heterogeneous compounds originally intended as probes of the endogenous cannabinoid system or as potential therapeutic agents. We assessed the clinical toxicity associated with recent SCRA use in a large cohort of drug overdose patients.

Methods

This subgroup analysis of a large (n = 3739) drug overdose cohort study involved consecutive ED patients at two urban teaching hospitals collected between 2009 and 2013. Clinical characteristics of patients with the exposure to SCRAs (SRCA subgroup) were compared with those from patients who smoked traditional cannabinoids (marijuana subgroup). Data included demographics, exposure details, vital signs, mental status, and basic chemistries gathered as part of routine clinical care. Study outcomes included altered mental status and cardiotoxicity.

Results

Eighty-seven patients reported exposure to any cannabinoid, of whom 17 reported SCRAs (17 cases, 70 controls, mean age 38.9 years, 77 % males, 31 % Hispanic). There were no significant differences between SRCA and marijuana with respect to demographics (age, gender, and race/ethnicity), exposure history (suicidality, misuse, and intent), vital signs, or serum chemistries. Mental status varied between SRCA and marijuana, with agitation significantly more likely in SCRA subgroup (OR = 3.8, CI = 1.2–11.9). Cardiotoxicity was more pronounced in the SCRA subgroup with dysrhythmia significantly more likely (OR = 9.2, CI = 1.0–108).

Conclusions

In the first clinical study comparing the adverse effects of SCRA overdose vs. marijuana controls in an ED population, we found that SCRA overdoses had significantly pronounced neurotoxicity and cardiotoxicity compared with marijuana.

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Acknowledgments

None.

Sources of funding

This study was supported in part by grant K23DA026476 from the National Institute on Drug Abuse (PI: AFM). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

Author information

Authors and Affiliations

  1. Emergency Medicine Residency, The Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Milana Zaurova

  2. Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA

    Robert S. Hoffman

  3. New York City Poison Control Center, New York City Department of Health and Mental Hygiene, New York, NY, USA

    Robert S. Hoffman

  4. School of Nursing, University of California, San Francisco, CA, USA

    David Vlahov

  5. Division of Medical Toxicology, the Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, One Gustave Levy Place, Box 1620, New York, NY, 10029, USA

    Alex F. Manini

Authors
  1. Milana Zaurova
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  2. Robert S. Hoffman
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  3. David Vlahov
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  4. Alex F. Manini
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Corresponding author

Correspondence to Alex F. Manini.

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Previous presentations

Presented in abstract form at the XXXV International Congress, European Association of Poisons Centres and Clinical Toxicologists, St. Julian’s, Malta, 2015.

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Zaurova, M., Hoffman, R.S., Vlahov, D. et al. Clinical Effects of Synthetic Cannabinoid Receptor Agonists Compared with Marijuana in Emergency Department Patients with Acute Drug Overdose. J. Med. Toxicol. 12, 335–340 (2016). https://doi.org/10.1007/s13181-016-0558-4

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  • DOI: https://doi.org/10.1007/s13181-016-0558-4

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